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General NPI Number Information
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NPI Number | 1114141470
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Entity Type | Individual
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Provider Name | ELANA MAURIN PHD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 375 CHIPETA WAY STE A
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1261
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Country | US
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Telephone | 801-587-3480
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Fax | 801-581-2771
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Provider Business Mailing Address
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Address Line | 375 CHIPETA WAY STE A
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1261
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Country | US
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Telephone | 801-587-3480
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Fax | 801-581-2771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6447291-2504
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License Number State | UT
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